Impact of optical coherence tomography scan direction on the reliability of peripapillary retinal nerve fiber layer measurements

PURPOSE: To evaluate the intradevice repeatability and agreement for peripapillary retinal nerve fiber layer (pRNFL) measurements in healthy eyes with two different scan directions and two different number of B scans. METHODS: pRNFL was measured with a spectral domain optical coherence tomography on 54 healthy participants. Three-dimensional optic disc scans (6 mm x 6 mm) were performed on the right eye of the participants. Two repeated scans were performed in four different settings: H1: Horizontal scan with 512 A-scans x 96 B-scans; H2: Horizontal scan with 512 A-scans x 128 B-scans; V1: Vertical scan with 512 A-scans x 96 B-scans; V2: Vertical scan with 512 A-scans x 128 B-scans. The pRNFL thickness was evaluated in twelve clock-hour sector in a circle of 3.45 mm diameter centred at the optic disc. Repeatability and agreement were assessed with within subject standard deviation (Sw) and Bland-Altman test respectively. RESULTS: The repeatability of pRNFL measurements varied depending on the scan direction and sectors. The repeatability for the horizontal sectors were better with H1 and H2, with sector 9 having the best Sw (< 3 μm). The repeatability for the vertical sectors were better with V1 and V2 with sector 5 and 9 having the best Sw (< 4 μm). The repeatability with vertical scan was more symmetric among the sectors than with horizontal scans. The repeatability metrics of the sectors did not vary much between H1 and H2 (difference < 2 μm) and between V1 and V2 (difference < 3.2 μm). Comparing horizontal and vertical scans, the vertical sectors had larger limits of agreement of about 45 μm. CONCLUSION: The reliability of the pRNFL thickness measurements is dependent on the direction of the scan and independent on the numbers of B-scans. Vertical scans for pRNFL gives more homogeneous repeatability across the different sectors.